Management
of Fibroids
Fibroids are the most common pelvic tumors found in
females. They are the most frequent cause if hysterectomies;
they have the highest incidence in the fifth decade
of a woman's life, and they are more frequent in black
women. While they are rarely malignant before menopause,
the growth of uterine fibroids after menopause is of
particular concern since this may relate to a malignant
change. Symptoms related to fibroids develop from the
enlarging pelvic mass, and these include any of the
following:
- Pressure sensation
- Painful periods
- Abnormal uterine bleeding
- Infertility
- Pregnancy complications, including miscarriages,
premature labor, or interference with labor resulting
in cesarean delivery
- Urinary symptoms of urgency and frequency and,
at times, stress urinary incontinence
- Constipation or changes in bowel habits
Fibroids may be microscopic or extremely large in
size. Although most occur in the uterus, fibroids are
of smooth muscle origin, and as such they may occur
in any structure having smooth muscle. Fibroids are
classified according to their relative location in
the layers of the uterus:
- Intramural - found in the wall of the
uterus
- Subserous - found near the outer covering
(serosa) of the uterus
- Submucous - found near the inner lining
(the endometrium) of the uterus
Although the submucosal location occurs in only 5-10
percent of fibroids, they are the most significant
clinically. Submucous fibroids can cause abnormal bleeding
and miscarriages, as well as infertility. No reason
has been established as to why these tumors develop
in some women and not in others. Their cause is not
completely understood, and neither is their propensity
for growth. The incidence of malignancy in fibroids
is 0.3 - 0.7 percent. They are rare before the onset
of menarche (menstruation) and generally decrease in
size after menopause. This observation implies that
they are stimulated by estrogen; accordingly fibroids
may enlarge during pregnancy and in response to the
use of oral contraceptives. Conversely, medically or
surgically induced hypoestrogenic states will decrease
the size of fibroids (i.e.: surgical removal of the
ovaries or the use of mediations which block the production
of estrogen.).
The diagnosis of fibroids is made by taking a careful
history and pelvic examination, which is then confirmed
by a pelvic/vaginal ultrasound scan. Computer Tomography
(CT) and Magnetic Resonance Imaging (MRI) are more
expensive and do not improve upon clinical management.
Hysterosalphingraphy (x-ray picture of the uterine
cavity) and hysteroscopy (direct visualization of the
uterine cavity) are used at times to further evaluate
the nature if the fibroids, especially in the infertile
woman.
The management of fibroids depends on many clinical
factors, including the age and reproductive needs of
the woman, as well as the severity of the symptoms.
The patient must have a basic understanding of the
nature and behavior of fibroids, as well as a trusting
relationship with her gynecologist in order for her
to make an intelligent treatment choice.
Since most women do not experience symptoms related
to their fibroids, judicious observation is the treatment
of choice following the initial pelvic exam and ultrasound
scan confirmation. Re-evaluation every six months is
adequate. Symptomatic women, however, should be evaluated
and have treatment based on clinical observations.
If the preservation of reproductive potential is the
primary concern, then myomectomy (removal of the tumor
only) is the treatment of choice. Whether this is done
through an open incision or operative laparoscopy depends
on the gynecologist's surgical skills and the size
of the tumors. Most cases are treated through open
incisions. The patient must be aware that reoccurrence
is a possibility.
When reproduction is no longer an issue, vaginal or
abdominal hysterectomy is a choice for definitive therapy.
Myomectomy in this group of patients can be considered
and discussed with the patient with the understanding
that it may not be in her nest interest. However, the
gynecologist must take into consideration the ethnic,
religious and psychological needs of the patient.
Endometrial Ablation, the thermal destruction of the
endometrium through laser electrocautery, is a choice
to deal with excessive bleeding in selected individuals.
Newer ideas of management, such as uterine artery embolization
(cutting off the blood supply of the fibroids) and
laparoscopic myoma coagulation, a similar modality,
have not be tested and have unknown long-term results.
Treatment of fibroids through medication is based
on the fact that fibroids are estrogen dependent and
reduction of circulating estrogen will reduce the size
of the fibroids. Although progesterone has been used
for this purpose, the most effective medical management
involves the use of GnRH agonists (Lupron), which blocks
the production of estrogen. GnRH agonists are capable
of reducing the fibroid to 40 - 90 percent of original
volume. They are given as monthly injections for six
doses. The problem with this class of medications is
that their side effects include severe menopausal symptoms,
as well as the development of osteoporosis; hence they
can only be used for six months. Following the cessation
of the medication, the fibroids will grow to their
original size and, at times, even larger.
In summary, fibroids are the most commonly occurring
pelvic tumors in females. They are rarely malignant.
Most fibroids cause no symptoms and only require careful
observation as a form of management. When symptomatic,
fibroids need to be fully evaluated and therapy should
be tailored according to clinical consideration.
If you think you have fibroids and need a
referral to an obstetrician/ gynecologist in your
area, please call
1-888-SBMC-DOC.
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Parenting
Insights Develops New Format
To help new parents in their transition to home and
assist with the acquisition of parenting skills, the
Family Centered care nursing team at Saint Barnabas
offers new families a free informational meeting called Parenting
Insights. Health every Tuesday from 2:00 p.m.
to 3:00 p.m., Parenting Insights is an informational
gathering and an opportunity to meet other new parents,
compare ideas about baby care and ask Saint Barnabas
nurses a variety of parenting questions.
Now, Parenting Insights has
developed a new format to further
meet the needs of families. Sessions will now cover
specific topics and an ongoing four-week program has
been developed. New families may begin attending at
nay time during the course of the four weeks.
Week One, held the first Tuesday
of every month, will offer parents a program on "Diet
and Exercise." A lecture will be provided by a dietician
and physical therapist and a question and answer period
will follow.
Week Two, Health the second Tuesday
of every month, will focus on "Infant Massage, Immunization
and Safety." A demonstration and film on infant massage
will be shown and parents will have time to participate.
A lecture on the importance of immunizations will follow
and a schedule of immunizations by age will be distributed.
The infant safety portion of the program will provide
information from the New Jersey Poison Control Center
and a discussion of home safety and basic first aid.
In Week Three, held the third Tuesday
of every month, sessions will focus on "Infant Growth
and Development" from birth to four months of age.
Parents will learn what to expect and gain tools for
assisting in the development of their child.
Week Four, held the fourth Tuesday
of every month, covers "Going Back To Work," and will
explore the emotional aspects of such a return as well
as practical matters, such as the selection of day
care facilities.
In a month with five Tuesday, Parenting Insights will
not be held on the fifth Tuesday.
Newborns in car seats or strollers are welcome to
attend Parenting Insights, and refreshments
are served. Free parking is available, but please allow
plenty of time as space is limited. Reservations are
required by calling (973) 322-2584.The program
is held at the Ambulatory Care Center.
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Saint Barnabas Offers
Free Support Classes For Nursing Mothers
Breastfeeding is one of natures' ideal systems. Just
as a mother is capable of nourishing her baby for months
in the womb, she is also capable of completely nourishing
him at the breast. Breast milk is the ideal food for
your baby, and it is all that he will need to thrive
and grow for the first months of his life.
The benefits of breastfeeding can begin after your
baby's birth. A baby put to your breast immediately
after experience of being born is comforted by the
warmth and touch of you body. Hearing the familiar
beat of your heart and the sound of your voice and
finding a place to suck will be claming. It will ease
his introduction to the outside world.
By choosing to breastfeed, you will help to protect
your baby from common early-childhood illnesses such
as colds, ear infections, and diarrhea, especially
during the early weeks and months of his life. Your breast
milk is suited to your baby. It changes from
hour to hour and day to day. depending on your baby's
needs. It is always available at the right temperature,
doesn't need any mixing or equipment, and cost very
little.
Breastfeeding also has clear advantages for you. Many
mothers feel that nothing else creates a closer bond
between themselves and their babies. Most babies can
be quickly clamed and reassured by being out to their
mother's breast. Breastfeeding will also help you get
back into shape by speeding the return of your uterus
(womb) to its normal size. And studies show that women
who breastfeed may be less likely to develop breast,
uterine and ovarian cancers.
There is some evidence, too, that nursing offers protection
against osteoporosis (brittle bones), which can occur
later in life. And breastfeeding generally lengthens
the time before menstrual periods resume. Most nursing
women find they don't have a menstrual cycle for several
months after delivery, so long as they are nursing
frequently.
All nursing mothers appreciate the money they save
by not buying formula. Mothers committed to providing
their children with wholesome, natural foods see breast
milk as a sound beginning.
Experienced nursing mothers boast about the ease and
convenience of breastfeeding. They are often quick
to add that information, guidance, support and reassurance
were essential at the start.
At Saint Barnabas Medical Center, we are committed
to assisting new Moms get off to the best start with
breastfeeding, even after they leave the hospital.
Starting on the first Tuesday of every month, a series
of four "classes" is offered for new, breastfeeding
Moms (babies included, of course!) from 1:00 - 2:00
p.m. at the Saint Barnabas Ambulatory Care Center.
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Robert
R. Taylor, M.D. Joins Saint Barnabas Medical Center
Department of Obstetrics and Gynecology
Robert R. Taylor, M.D., a resident of Morris Township,
recently joined the Department of Obstetrics and Gynecology
at Saint Barnabas Medical Center as Associate Director
of the Division of Gynecology Oncology. Dr. Taylor
shares clinical, administrative and educational responsibilities
related to gynecology oncology, pelvic reconstructive
surgery and consultative gynecology.
"I am pleased to join Saint Barnabas Medical Center
and its Department of Obstetrics and Gynecology," explains
Dr. Taylor. "I hope to make a positive impact on the
delivery of subspecialty gynecologic care to the community
by continuing to provide proven and current therapeutic
gynecologic oncology options."
The entire Department, particularly the Division of
Gynecology Oncology and Reconstructive Pelvic Surgery,
is extremely pleased that Dr. Robert Taylor, former
head of the Division of Gynecologic Oncology at the
Walter Reed Army Hospital Medical Center in Washington,
DC, has joined this Division as Associate Director,
said James L. Breen, M.D., Chairman of the Department
of Obstetrics and Gynecology.
"His record is more than outstanding and he adds a
great dimension to this Division with regard to research
and patient care," Dr. Breen said.
Prior to joining Saint Barnabas Medical Center, Dr.
Taylor was in charge of the Gynecology Oncology Division
at the National Capital Uniformed Services at Walter
Reed Army Medical Center in Washington, DC. He additionally
served as an Associate Professor of Clinical Obstetrics
and Gynecology at The Uniformed Services University
in Bethesda, MD, and Assistant Professor of Obstetrics
and Gynecology at Johns Hopkins University in Baltimore,
MD.
Board Certified by the American Board of Obstetrics
and Gynecology Division of Gynecologic Oncology and
the American Board of Obstetrics and Gynecology, Dr.
Taylor graduated from The Uniformed Services University
of Health Services. He completed a residency in obstetrics
and gynecology at The National Naval Medical Center,
Bethesda, MD, and a fellowship in gynecologic oncology
at The Uniformed Services University. He also completed
a post doctoral research fellowship at the National
Cancer Institute.
The Gynecology Oncology Division at Saint Barnabas
Medical Center continues to be one of the five largest
and most recognized centers in the northeast. The division
provides a comprehensive range of services necessary
centers in the northeast. The division provides a comprehensive
range of services necessary for the proper treatment
of gynecologic malignancies and works closely with
the Department of Radiology Oncology in the treatment
of patients with gynecologic cancer.
For further information or to make an appointment,
call (973) 322-5280. |
